Engorgement Management

Postpartum engorgement often occurs after a mother’s breast milk comes in. It is often related to swelling rather than “too much milk” in the breast.

Symptoms include extreme fullness and swelling in the breasts. These symptoms usually occur 3-5 days postpartum. Engorgement may happen as late as 10 days postpartum, although this is less common in women who have had multiple children.

Recommendations to manage engorgement

To prevent engorgement:

  • Learn to get a good, deep latch and feed frequently in the early days after delivery.
  • Hand express if your baby is sleepy and spaces between feeds (this happens after initial feed during the first 24 hours after delivery). 
  • Nurse frequently: 8-12 times during a 24-hour period and in response to your child’s cues. Remember, cluster feeding is normal!
  • Keep your child actively nursing throughout the feed.
  • Do not skip feeds (especially night feeds) or give supplemental feeds in the first few weeks unless advised by your doctor.

If engorgement occurs:

  • For symptomatic relief, apply ice for 20 minutes every hour, or more frequently if desired. A bag of frozen vegetables works well to cover a larger area.
  • Take a warm shower before nursing to improve milk flow.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen can be used to reduce swelling and relieve pain.
  • Use hand expression to relieve symptoms and provide breast milk for infants who are not able to latch due to engorgement. (Click here to watch a video about hand expression best practices.)
  • Perform reverse pressure softening. (Click here to watch a video about reverse pressure softening.)
  • If your child is having trouble latching due to swelling, use hand expression or a manual pump to remove small volumes of milk. Do not aim to “empty” the breasts unless your child is not feeding from your breasts and supplemental milk is needed.
  • Lymphatic massage can be very helpful to help drain the fluid that is causing engorgement. (Click here to watch a video about lymphatic massage best practices.)

More engorgement phase tips

  • Feed your child on demand, especially at night.
  • Minimize pump usage. Mechanical breast pumps stimulate breast milk production without removing the milk as effectively as a baby will, worsening swelling.
  • Wear an appropriately fitting, supportive bra that isn’t too tight. Lactating breasts are highly vascular and require support to avoid excessive swelling as well as progressive back and neck pain.